Strengthening Civil Registration Through Grassroots Health Institutions in India.

Civil registration of births and deaths underpins people's legal identity, access to essential services, and evidence-based policy. Over the last two decades, the expansion of the National Health Mission (NHM) and the dramatic increase in institutional deliveries have created new opportunities to link maternal healthcare with critical event documentation. Primary health centres (PHCs) and community health centres (CHCs), which are frequently the initial point of contact for rural households, are emerging as important places for birthing and registration. Despite their expanding importance, the particular role of these grassroots facilities in birth registration results has not been thoroughly investigated. This study addresses that gap by assessing their role in increasing registration coverage among children under the age of five. We analyzed nationally representative data from the National Family Health Survey rounds 4 (2015-2016) and 5 (2019-2021). This study focused on children under five, examining the association between place of delivery and registration status. Descriptive analysis and multivariable logistic regression estimated the odds of registration across delivery settings. Pooled data from both survey rounds captured temporal shifts, and predicted probabilities were calculated for institutional deliveries, adjusting for socio-demographic covariates. The proportion of institutional births occurring in PHCs and CHCs rose from 30.5% to 34.7% between the two survey rounds. Registration among children delivered in these facilities increased from 80.8% to 90.2%, the highest gain among all delivery settings. Regression analysis showed that births in PHCs/CHCs were associated with 38% higher odds of being registered compared to private facilities. States designating PHCs and CHCs as official registrars, such as Delhi, Rajasthan, and Uttar Pradesh, reported the greatest improvements. Lower-level government health facilities are not only advancing safe delivery but also acting as pivotal nodes for civil registration. Their dual function creates a scalable model for integrating healthcare with legal identity creation, supporting equity and accelerating progress toward Sustainable Development Goal 16.9.